Is albumin administration in hypoalbuminemic elderly cardiac surgery patients of benefit with regard to inflammation, endothelial activation, and long-term kidney function?
BACKGROUND
Because patients with low albumin levels may benefit from human albumin (HA) administration, we studied correction of hypovolemia with HA in hypoalbuminic elderly cardiac surgery patients.


METHODS
In a prospective, randomized study, 50 patients aged >80 yr undergoing cardiac surgery using cardiopulmonary bypass with a preoperative serum albumin concentration of <3.5 mg/dL, received either 5% HA (n = 25) or hydroxyethyl starch (6% HES 130/0.4) (n = 25). Volume was added to the priming (500 mL) and given until the morning of the second postoperative day to keep pulmonary capillary wedge pressure or central venous pressure between 12 and 14 mm Hg.


RESULTS
Inflammatory response (interleukins-6, -10), endothelial activation (intercellular adhesion molecule-1), and kidney function (including glutathione transferase-alpha and neutrophil gelatinase-associated lipocalin) were measured after induction of anesthesia, 5 h after surgery, and the first and second postoperative day. A follow-up, approximately 60 days after discharge from the hospital, was done. Two thousand nine hundred eighty +/- 430 mL of HA and 3060 +/- 680 mL of HES 130/0.4 were given. Serum albumin concentration was significantly increased by HA (to 4.5 +/- 0.3 mg/dL). Serum creatinine, glomerular filtration rate, and urinary levels of alpha-glutathione transferase and neutrophil gelatinase-associated lipocalin were not different in the HA-compared to the HES-treated patients. The inflammatory response was similar in both groups, whereas endothelial activation was less in the HES group. None of the patients developed renal failure requiring renal replacement therapy.


CONCLUSIONS
Use of HA in hypoalbuminemic cardiac surgery patients aged >80 yr was without benefit with regard to inflammatory response, endothelial activation, and renal function compared to 6% HES 130/0.4.
Boldt
Joachim
J
Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Bremserstr. 7, D-67063 Ludwigshafen, Germany. BoldtJ@gmx.net
Brosch
Ch
Ch
Röhm
K
K
Lehmann
A
A
Mengistu
A
A
Suttner
S
S
D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002405:Catheterization, Central Venous; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D017558:Elective Surgical Procedures; D005260:Female; D005919:Glomerular Filtration Rate; D019918:Heart Valve Prosthesis Implantation / Q000706:statistics & numerical data; D006801:Humans; D034141:Hypoalbuminemia / Q000453:epidemiology* / Q000628:therapy*; D016753:Interleukin-10 / Q000097:blood; D015848:Interleukin-5 / Q000097:blood; D007677:Kidney Function Tests; D008297:Male; D012016:Reference Values; D012709:Serum Albumin / Q000378:metabolism / Q000627:therapeutic use*; D016896:Treatment Outcome
D015848:Interleukin-5; D012709:Serum Albumin; D016753:Interleukin-10